Integrated HRA

An integrated Health Reimbursement Arrangement (HRA) is a traditional HRA that's paired with — and can only be offered alongside — a group health plan. The employer funds the HRA with a defined dollar amount each year that employees can use to reimburse qualified medical expenses (including deductibles and cost-share on the underlying group plan). It's the older, more common HRA structure, distinct from the newer standalone HRA designs (ICHRA and QSEHRA) that were created to allow HRA funding without a group plan.

Integrated HRAs are typically designed to work with a high-deductible group plan — the employer buys a plan with a $5,000 deductible and funds a $2,000 HRA, giving employees effective coverage of $2,000 pre-HRA plus $3,000 of member-responsible deductible. The HRA can be structured to pay first (from the first dollar) or last (only after the member meets a threshold). Unused HRA funds can roll over to the next year at the employer's discretion, and the funds are not portable — they belong to the plan and revert to the employer when the employee leaves. Integrated HRAs are subject to the ACA's requirement that they be integrated with an ACA-compliant group plan; standalone HRAs (without integration) were prohibited under the ACA until ICHRA rules were finalized in 2019.

The takeaway: if you're an employer using a high-deductible group plan, an integrated HRA can meaningfully reduce employee out-of-pocket risk while giving you tax advantages the employer keeps if unspent. It's a common pairing that gets less attention than it deserves in cost-sharing conversations.